this study aims to assess the short-term (3-month) clinical and echocardiographic outcomes of primary PCI among STEMI patients from rural versus urban areas in Upper Egypt. A special focus will be placed on identifying predictors of MACE. The findings may offer valuable insight into optimizing STEMI care pathways and support the development of regional STEMI networks across Egypt.

ST-segment elevation myocardial infarction (STEMI) is a life-threatening condition that requires urgent reperfusion therapy, with primary percutaneous coronary intervention (PCI) being the gold standard of care. While PCI significantly reduces complications and improves survival, access to this intervention remains unequal, particularly between rural and urban populations

According to the latest census definitions, a rural area is characterized by:A population of fewer than 5,000,A population density of less than 400 persons per square kilometer,And more than 25% of the male working population engaged in agriculture.

Rural patients often experience delayed diagnosis, limited access to PCI-capable centers, and prolonged ischemic times. These factors contribute to poorer clinical outcomes, including higher rates of reinfarction, heart failure, and mortality. In contrast, urban residents typically have faster access to specialized cardiac care and more efficient treatment pathways.

In Upper Egypt, this urban-rural gap is particularly pronounced, with rural patients facing substantial logistical and systemic challenges in receiving timely PCI. Although efforts have been made to expand PCI access nationwide, there remains a lack of localized data comparing short-term outcomes-particularly major adverse cardiovascular events (MACE)-between rural and urban STEMI patients.

Inclusion Criteria:

• 1. Adults aged ≥18 years. 2. Confirmed diagnosis of ST-segment elevation myocardial infarction (STEMI) based on ECG and cardiac biomarkers.

  3. Underwent primary percutaneous coronary intervention (PCI) within the study period.

  4. Known and verified residential address classified as rural or urban based on official definitions (e.g., UK or WHO classification).

  5. Informed consent obtained

Exclusion Criteria:

1. Non-STEMI or unstable angina cases.

2. Patients who received fibrinolytic therapy instead of PCI.

3. Transfer from another facility after more than 12 hours of symptom onset.

4. Patients with previous revascularization (e.g., CABG or PCI within the last 6 months).

5. Incomplete clinical data or unknown residential location.

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patients Confirmed diagnosis of ST-segment elevation myocardial infarction (STEMI) based on ECG and cardiac biomarkers.